Flat-foot test Ask the patient to stand, with the weight spread evenly between both feet. Place one end of a ruler at the inferior aspect of the medial malleolus and the other end of the ruler at the base of the first metatarsal. Locate the navicular tuberosity and compare its location with the straight edge of the ruler. If the navicular tuberosity lies below the straight edge, then this indicates flat foot – fallen medial longitudinal arch.

Feiss line test

This is similar to the flat-foot test and involves drawing a line between the medial malleolus and first metatarsal to mark the navicular tuberosity (Figure 2). There are several grades of flat foot:

n Grade 1: the navicular tuberosity falls one-third of the distance to the floor. n Grade 2: the navicular tuberosity falls two-thirds of the distance to the floor. n Grade 3: the navicular tuberosity is in contact with the floor.

Calcaneal squeeze test Ask the patient to lie prone, with the knee of the side to be tested flexed to 90o

and note any signs of pain or discomfort: n Sides of the calcaneus n Posterior aspect of the calcaneus – calcaneal tuberosity n Medial calcaneal tubercle

If squeezing the sides of the calcaneus elicits pain or discomfort, this indicates possible calcaneal fracture; the patient should be referred for an X-ray or scan. Pain or discomfort on squeezing the posterior calcaneus may indicate retrocalcaneal bursitis or fracture; again, refer on. If squeezing the medial calcaneal tubercle produces pain or discomfort, this indicates plantar fasciitis See La Trobe presentation).

Metatarsal squeeze test and Mulder’s test The metatarsal squeeze test (see online box) can be used to assess for synovitis of any of the metatarsophalangeal (MTP) joints and, if positive, should be followed up by palpating each joint for tenderness. Metatarsalgia is identified by less localised pain under the metatarsal heads and no paraesthesia. Deep peroneal neuropathy pain occurs between the first and second toe. The web spaces between the MTP joints should be palpated for tenderness to assess for neuromas, especially the third/ fourth web space, an area of neuropathy often termed Morton’s neuroma. Mulder’s click test (see online box) is a ‘click’ that can be felt due to the swollen nerve impinging against the intermetatarsal ligament. The thumb and index finger are used to palpate for the ‘click’ in the relevant intermetatarsal space, whilst the metatarsal heads are squeezed together. Pain or discomfort localised to the metatarsal shaft may indicate fracture.

Subtalar glide test Ask the patient to lie supine. Stabilise the talus and apply medial and then lateral force on the calcaneus. Pain, discomfort or displacement of the calcaneus indicates subtalar instability or strain.

10

INFERIOR ASPECT OF MEDIAL MALLEOLUS

NAVICULAR TUBEROSITY

OF FOOTWEAR DEMONSTRATES ANY MARKED ABNORMAL WEAR PATTERN

IT IS VITAL TO REFER THE PATIENT TO A PODIATRIST IF EXAMINATION

BIOMECHANICAL PROBLEMS ELSEWHERE Flat foot/overpronation can cause strain of the lumbosacral and sacroiliac joints, and valgus stress on the knee. It can also rotate the hip, tighten the iliopsoas and lead to piriformis trigger points or sciatic nerve entrapment.

A high arched foot can lead to knee pain, tensor fascia and ITB tightening, and hip and lower back pain. If in doubt, send the patient for assessment with a gait

BASE OF FIRST METATARSAL

Figure 2: Feiss line test

. Carry out the following three squeezes

analyst or podiatrist. FURTHER READING

Booher JM, Thibodeau. Athletic injury assessment. Mosby College Publishing 1985. ISBN 0801607116 Karageanes SJ. Principles of manual sports medicine. Lippincott Williams & Wilkins 2005. ISBN 0781741890 Vizniak NA. Physical Assessment, 3rd edn. Professional Health Systems ISBN 9780973274202. www.prohealthsys.com/products

References 1. Watt J. What’s your problem? A ready reckoner to patient assessment. sportEX dynamics 2007;11:8-9 2. Watt J. Assessment of the knee joint. sportEX dynamics 2007;12:14-15 3. Watt J. Assessment of the ankle joint. sportEX dynamics 2007;13:11-13 4. Watt J. Assessment of the hip joint. sportEX dynamics 2008;17:18-21

online

n Articles - related articles in the sportEX archive - references 1-4 including a series of template printable patient assessment forms n Presentation - PDF presentation from La Trobe University, Australia http://tinyurl.com/8znoade n Videos - showing over pronation during gait, the metatarsal squeeze test and Mulder’s click test

THE AUTHOR

Joan Watt is a chartered physiotherapist and sports massage practitioner. She has worked at numerous Olympic and Commonwealth Games. She continues to travel widely as both a practitioner and a manager, and she is currently manager of the

GB Shooting Team. Joan is president of the SMA and the CSP massage and soft tissue therapy group.

sportEX dynamics 2009;19(Jan):9-10

© PRIMAL PICTURES 2009